ABSTRACT
Background: Following the use of COVID-19 vaccines worldwide, few cases of severe allergic reactions were reported. According to recent Portuguese guidelines, patients (pts) with suspected allergy to a COVID-19 vaccine component, history of anaphylaxis following vaccination, idiopathic anaphylaxis and mast cell disorders, should be referenced for Immunoallergology evaluation. Fear of a hypersensitivity reaction, especially among pts with allergic disease, is associated with lower vaccine adherence. This study aimed to evaluate BNT162b2 vaccination outcomes in pediatric pts with suspected severe allergic reactions prior to or after vaccination. Method(s): W e c onducted a p rospective s tudy i ncluding p ediatric pts with high risk of allergy to COVID-19 vaccine referred to Immunoallergology Department of a Tertiary Hospital. Demographic data, primary medical conditions and vaccination status were collected. After a detailed assessment by an allergologist, in selected cases, BNT162b2 vaccine administration in hospital facilities was performed, followed by a 1-hour observation period. Result(s): Twenty-two pts were included (18 males, 13.1+/-2.6years;min 7, max 17;13 atopic), referenced mainly from primary care (9) and other specialties (8). Most of the pts were referenced for the first dose of vaccine (18), due to mastocytosis/tryptasemia (5), previous allergic reaction to another vaccine (4), idiopathic anaphylaxis (3), complex comorbidities (2), drug anaphylaxis (1), parental reluctance (1), other (2). Four pts were evaluated for the second dose of COVID-19 vaccine, due to an acute urticaria after the first BNT162b2 vaccine dose. Three pts were eligible, after our evaluation, for primary care vaccination, that occurred without adverse reactions. Regarding the remaining 19 pts eligible for hospital vaccination, 13 were premedicated with oral antihistamines +/- montelukast. Eleven pts received BNT162b2 vaccine in hospital facilities [first dose (9);second dose (2)] with no reported adverse events. Vaccine administration was postponed in 3 pts due to SARS-CoV- 2 infection and 1 due to parental hesitancy. Conclusion(s): Our data support that allergic reactions to BNT162b2 vaccines are rare, even in the pediatric population with high risk of allergic reactions or with a history of previous severe allergic reactions. The favourable safety profile outcomes, along with the risk reduction of allergic reactions, increase vaccine confidence, broadening community protection.
ABSTRACT
Background: COVID-19 vaccination is essential for the pandemic control. Adverse reactions after vaccination are com-mon, although anaphylaxis is rare. Objective(s): To characterize the immunoallergological reactions responsible for pre--vaccination referral by Primary Care (PC), to analyze the impact of drug allergy on this referral, and to evaluate the vaccination outcome after risk stratification. Method(s): Retrospective observational study including patients referred by PC to the Allergy & Clinical Immunology Department of a tertiary hospital to evaluate the risk of severe hypersensitivity reactions (HSR) after COVID-19 vaccination, from January to June 2021. Risk stratification was carried out in accordance with the Allergy & Clinical Immunology Department's protocol. Result(s): From a total of 733 patients referred by the CSP, 510 were admitted, 445 of which were evaluated, 369 (83%) females, mean age 66+/-13 years [20-99 years], 122 (27%) atopic. The majority (n=349, 78%) were referred due to previous drug reactions, of whom 69 (15.5%) due to vaccine reactions. Nonste-roidal anti-inflammatory drugs (n=97, 51%) and antibiotics (n=70, 36%) were the most reported drugs in suspected/confirmed HSRs. Drug reaction profile differed in low-risk (61% with HSR, 39% anaphylaxis) and intermediate/high risk (92% with HSR, 65% anaphylaxis) patients. After risk assessment, 323 patients were referred for vaccination at the vaccination center, of whom 280 received at least one dose of the vaccine. Two patients had chronic urticaria worsening and one patient had a vasovagal reaction after the vaccine. 122 patients were vaccinated at the hospital, of whom 69 received one dose of the vaccine. Only two patients had mild skin reactions. Conclusion(s): Drug allergy was the main cause for pre-vaccination risk assessment. Most patients were vaccinated at the vaccination center with no HSR. Risk assessment protocol was effective, with no significant reactions or cases of anaphylaxis. Copyright © 2022, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.
ABSTRACT
Background: Subcutaneous immunotherapy with aeroallergen (SCITA) was stopped in some departments during the lock-down period due to the COVID-19 pandemic. Objectives: To evaluate the impact of SCITA interruption on symptoms, the need for control medication, the quality of life, and the expectations and degree of safety / fear of patients on returning to the hospi-tal. Methods: Self-completion of an anonymous survey for patients over 12 years in the first 5 weeks of SCITA restart. CARAT was used as an instrument to assess rhinitis and asthma control. Results: 77 patients (90% adults, 68% women) were included, all with rhinitis and 40% with asthma. The average time interval between the last administration and the restart of SCITA was 13 ± 2.48 weeks. Seven percent of patients were seen in an emergency / unscheduled appointment due to the exacerbation of respiratory symptoms and only 1 had COVID-19. CARAT-Total scores showed control of rhinitis and asthma, respectively, in 35% and 66% patients. The proportion of uncontrolled patients rised with the increase in the SCITA interruption period (IP). The majority (> 90%) of patients reported no significant impact on their quality of life and maintained the usual control medication (48%), expressed concern about losing the benefits of SCITA with its interruption (62%) and reported feeling safer in the vaccination offices compared to the hospital building or waiting room. Conclusions: An increase in the frequency of uncontrolled patients with an increase in IP was observed. For most patients, the IP did not have a significant impact on quality of life. The frequency of patients who needed to be observed in an emergency / unscheduled appointment was low and only 1 reported having had COVID-19. The perception of safety in the vaccination room is higher than in the hospital’s common spaces. © 2021 Sociedade Portuguesa de Alergologia e Imunologia Clínica. Published by Publicações Ciência & Vida.